Statins have proven their worth in the fight against heart disease and stroke over many years. Statins can be used in either primary prevention (to prevent the first occurrence of a cardiovascular event), or secondary prevention (to prevent recurrence of a cardiovascular event). The benefits in people who are at high risk for an event is well supported in the literature, where high risk can be considered secondary prevention, or primary prevention in those with significant risk for a cardiovascular event, such as those with diabetes, strong family history of stroke or heart attack, or history of transient ischemic attack. In older adults over 80 years old, there are no data to support use of statins in primary prevention. So what if you are taking a statin for primary prevention and you are over 80? The simple answer: It’s on a case-by-case basis in which an informed decision needs to be made by the person taking the drug and physician, understanding the benefits, and what side-effects to expect and monitor for. There is mounting controversy surrounding the risks of these drugs in older adults since these drugs are not without significant side-effects, such as muscle weakness leading to falls, muscle pain advancing to a potentially life-threatening condition called rhabdomyolysis, and memory loss, among others. My intent is to paint a picture that can assist you in having a more thoughtful conversation with your physician when considering use of one of these drugs, or when you are suspecting a side-effect.
FALLS- Older adults are less likely to tolerate a medication since, as the body ages it loses capacity to cope with potential side-effects, which can be referred to as the “loss of reserve capacity”. Since muscles lose mass and strength with age, and the brain actually shrinks with age, we are less likely to have the “reserve capacity” to tolerate an insult from a medication. This was proven in one study where statins were correlated with an increased risk for falls in older adults, with an odds ratio (OR) of 1.5. That means a 50% greater risk of falling when taking a statin.
MEMORY LOSS- In several studies, statins have been correlated with memory loss, and in some individuals, the diagnosis of Alzheimer’s disease was removed from their health record when memory loss resolved after discontinuation of a statin. Some references debate the validity of these cumulative case reports, yet the evidence continues to mount. My best interpretation is you should be persistent in seeking a medication-related cause when memory loss develops while using a statin, to the point that the drug as a cause should be ruled out. Your physician can evaluate if stopping the statin for a few weeks will have any effect on your risk for a cardiovascular event, of which a brief holding of a statin most likely will not have any impact on risk.
GERIATRICIAN PERSPECTIVE- As taken from an article written by a geriatrician, David G Le Couteur, Pharmaco-epistemology for the prescribing geriatrician, Australasian Journal on Ageing, Vol 27 No 1 March 2008, 3–7, he states that no physician can actually measure whether medication effects are beneficial in their practice. He says, “It is not feasible for a clinician to have any personal experience or insight into whether many, if not most medications, have any efficacy or usefulness. Many medications are designed to reduce the risk of developing illness and it is almost impossible for a clinician to detect the absence of an illness. Furthermore, the numbers needed to treat (NNT) for many medications are so large that no individual clinician has enough patients to be aware of any impact on outcomes.” So let’s see what other way we can look at this: If we need to treat 80 people with a statin to prevent one negative event, yet memory loss develops in 1 or 2 in a hundred, and muscle pain develops in as high as 5 to 8 out of a hundred, we have a conundrum in which the benefits may not be measurable, yet the risk for an adverse event (side-effect) can be significant and may exceed the chances of any benefit. This then leads to the need to evaluate risk vs. benefit.
In conclusion, just adding a drug to your regimen to reduce risk sounds like it may benefit you, but there is also risk for adverse effects. So if you really want to take a statin, you may want to consider knowing more about what you should monitor for in terms of adverse effects. Should you do memory screening annually to measure any changes in cognition? Or should you also do balance testing each year to measure your risk for falling? Answer: Yes, whether you’re taking a statin or not. Measuring function in key areas may pick up on subtle changes in the body, where early detection may lead to action and prevent an adverse drug event , or lead to early intervention that can help maintain independence.